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Spinal Cord Stimulation (SCS) is an established technique for the treatment of refractory chronic pain, especially neuropathic pain. Careful patient selection is crucial to optimize outcomes and reduce therapeutic failures. SCS involves the implantation of epidural electrodes connected to a pulse generator, modulating pain transmission at the spinal cord level. It is mainly indicated for chronic neuropathic pain but is also used in other selected conditions. Main indications of SCS are: Refractory chronic neuropathic pain (e.g., Complex Regional Pain Syndrome, CRPS), PSPS type I and II (Failed Back Surgery Syndrome - FBSS, Chronic non-operable radicular pain/lumbar stenosis), Painful diabetic neuropathy, Critical limb ischemia (in selected cases) Inclusion Criteria, Clear and documented diagnosis. The ideal candidate has a definite diagnosis of chronic neuropathic pain, confirmed by clinical and instrumental tests (EMG, imaging, pain assessment scales such as DN4 or painDETECT).The SCS e-tool can be used to standardize and document these criteria efficiently, ensuring all key diagnostic steps are captured. Duration and severity of pain: pain present for at least 6 months ; severe intensity (VAS/NRS > 6/10); proven failure of conventional treatments (pharmacological, physiotherapy, injections).The SCS e-tool helps to track and record pain duration, severity, and previous therapies, making the selection process more objective. Response to previous treatments: the patient must have tried, without lasting benefit, at least two classes of medications (antiepileptics, antidepressants, opioids, etc.), plus physical and psychological therapies.This information can be systematically entered and monitored using the SCS e-tool. Psychological and motivational status: it is essential to exclude uncontrolled severe psychiatric disorders (major depression, psychosis, substance abuse). A pre-implant psychological assessment is recommended to identify risk factors for failure or complications.The SCS e-tool can include checklists or templates to ensure psychological criteria are properly evaluated and documented. Ability to manage the device:the patient must be able to understand and manage the device, with family support if needed.The SCS e-tool can help assess and record the patient’s ability to manage the device, as well as the availability of social support. Exclusion Criteria: Pain of non-neuropathic origin (pure nociceptive), active systemic or local infections, uncorrectable coagulopathies, significant psychiatric instability, limited life expectancy (<1 year), non-adherence to therapies or lack of social support.The SCS e-tool provides a structured exclusion checklist, minimizing the risk of missing contraindications. Multidisciplinary Evaluation: optimal selection requires a multidisciplinary approach, involving: Pain specialist, Neurosurgeon, Psychologist/Psychiatrist, Physiatrist.The SCS e-tool can be used collaboratively during team meetings to review, share, and document patient eligibility, ensuring all perspectives are considered and recorded. Stimulation Trial: before permanent implantation, a trial period (whose length varies considerably across different healthcare systems and even within individual countries) may be performed. Success is defined by pain reduction ≥50%, significant functional improvement, and subjective patient satisfaction. Only those who pass the trial proceed to permanent implantation. Prognostic Factors Positive Factors: pure neuropathic pain (vs. mixed), pain duration <2 years, absence of major psychiatric comorbidities, good family/social support, low dose opioids. Negative Factors: diffuse-poorly localized pain, high-dose opioid dependence, multiple surgical failures, poor motivation or compliance. The SCS e-tool can help to weigh these prognostic factors and track them over time for each candidate. Ethical Aspects and Informed Consent. It is essential to provide clear, complete, and realistic information about expectations, risks (infections, lead displacement, device malfunction), and the limitations of SCS. Informed consent must be thoroughly documented. Follow-up and long-term management. SCS requires regular follow-up to monitor clinical efficacy, manage complications or malfunctions, and optimize device programming. Multidisciplinary follow-up is recommended, especially in the first 12 months after implantation. Evidence and Guidelines. Major scientific societies (International Neuromodulation Society, EFIC, NICE) emphasize the importance of rigorous selection. Success rates exceed 60–70% in well-selected cases, but drop significantly if criteria are not met.The SCS e-tool can help ensure that your practice aligns with current guidelines and evidence-based protocols. Conclusion Patient selection for SCS is a complex process requiring the adoption of rigorous selection criteria: a multidisciplinary evaluation, accuracy, and attention to both clinical and psychological aspects are key elements for the success of SCS in chronic neuropathic pain. Careful selection increases the chances of success and reduces the risk of complications or dissatisfaction. The integration of the SCS e-tool streamlines each step, providing structured support for patient selection and allows for maximization of clinical benefits, minimization of risks, and a more effective and sustainable management of patients eligible for SCS.References Deer T, Pope J, Hayek S, et al. Neurostimulation for the treatment of axial back pain: a review of mechanisms, techniques, outcomes, and future advances. Neuromodulation 2014 Oct;17 Suppl 2:52–68. doi: 10.1111/j.1525-1403.2012.00530.x.North RB, Calodney A, Bolash R, et al. Redefining spinal cord stimulation ‘trials’: a randomized controlled trial using single-stage wireless permanent implantable devices. Neuromodulation 2020 Jan;23(1):96–101. doi: 10.1111/ner.12970. Epub 2019 Jun 3.Thomson S, Huygen F, Prangnell S, et al. Applicability and validity of an e-health tool for the appropriate referral and selection of patients with chronic pain for spinal cord stimulation: results from a european retrospective study. 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